Home Health Reimbursement Archives

Medicare Eligibility Verifications

By Melinda A. Gaboury, CEO / Posted on: September 20, 2021

This Monday Minute will touch on the significance of Medicare Eligibility Verifications and a key update to the content of Workers’ Comp and Liability Policies in the Common Working File. We will point out something that we have discovered, that could be a significant help in situations where you do that Eligibility Verification, so watch to learn more about Medicare Eligibility Verifications to have a successful enrollment.

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Phase 4 Provider Relief Funds and 60-day Grace Period

By Melinda A. Gaboury, CEO / Posted on: September 9, 2021

This Monday Minute reviews the content of the HHS announcement regarding the, now available, $25.5 billion in additional provider relief funds. 8 billion of this money is to be given to small providers primarily in rural areas and bonuses will be given to providers that serve primarily Medicaid, CHIP and/or Medicare patients.

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Implementation of the Notice of Admission

By Melinda A. Gaboury, CEO / Posted on: September 7, 2021

This Monday Minute will take you through the key elements of the coming Notice of Admission and provide references. We want to share with you a document that was published by Palmetto GBA, CGS and NGS, all three of the Home Health Medicare MAC’s this past week. This document goes through the details of what is going to be included in the Notice of Admission, beginning January 1st of 2022.

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Case-Mix Weight Changes in the HH Proposed Rule 2022

By Melinda A. Gaboury, CEO / Posted on: August 27, 2021

This Monday Minute provides thoughts about the potential impact of the proposed case-mix weight changes on overall reimbursement in 2022.

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Value Based Purchasing Nationwide Rollout 2022

By Melinda A. Gaboury, CEO / Posted on: August 20, 2021

This Minute briefly reviews some of the highlights of Value Based Purchasing and what has been proposed. Value-Based purchasing has been proposed in the form of a nationwide rollout for home health beginning in January 2022.

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Proposed CoP Changes that Need Your Feedback (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 9, 2021

This Minute reviews the four items that are being proposed for change in the Home Health Conditions of Participation, specific to home health aide supervision. Make sure to stay tuned for more updates!

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Review Choice Demonstration Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 26, 2021

This minute covers the update for Florida and North Carolina Home Health Review Choice Demonstration (RCD). Palmetto GBA provides HHAs with a wealth of information addressing the requirements and expectations of the RCD. Make sure to stay tuned!

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More Details on the 2022 Home Health Proposed Rule (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 12, 2021

This minute covers more details on the 2022 Home Health Proposed Rule. Register for our June15th webinar for more in depth information. Make sure to stay tuned!

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The Home Health Proposed Rule 2022 (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: July 6, 2021

This minute covers some of the changes for the Home Health Proposed Rule that were released on June 21st. Make sure to stay tuned!

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Provider Relief Funds Reporting Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 21, 2021

This minute covers the HHS revision of the Post-Payment Notice of Reporting Requirements as of June 11, 2021. This new version supersedes all previous versions of the Post-Payment Notice of Reporting Requirements documents. Make sure to stay tuned!

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Increase in COVID-19 Vaccine Administration Payments (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 14, 2021

This minute covers the news release from CMS concerning: Medicare Billing for COVID-19 Vaccine Shot Administration. Effective June 8 of 2021, CMS has now approved that the COVID vaccination administration payment is going to be $75 per shot, which is almost double what they had increased it to earlier this year. The emphasis on getting as many people vaccinated as we possibly can is apparent. Make sure to stay tuned!

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Home Health Value-Based Purchasing Annual Report (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 1, 2021

This Minute covers a review of the Home Health Value-Based Purchasing (HHVBP) Model – Fourth Annual Report. Make sure to stay tuned!

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Notice of Admission Transmittal (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 17, 2021

This Minute covers the highlights of Transmittal 10758, dated May 11, 2021 with updates to the Medicare Claims Processing Manual regarding the NOA implementation for January 2022. Make sure to stay tuned!

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The HEAT Act (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: May 3, 2021

Welcome to Monday Minute with Melinda! This Minute is a call to action regarding the Senate bill the HEAT Act. Please review and participate. Make sure to stay tuned!

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COVID Vaccine Administration Billing Update & Extension of the Public Health Emergency (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 26, 2021

Welcome to Monday Minute with Melinda! This session reviews the details of the Condition Code that must be used in billing vaccine administration for Medicare Advantage enrolled patients. Additionally, we touch on the extension of the PHE and corresponding CMS Waivers. Make sure to stay tuned!

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Sequestration, Reminder Regarding NPPs in Home Health & Update on Claims Processing (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 19, 2021

Welcome to Monday Minute with Melinda! Welcome to Monday Minute with Melinda! This session is loaded with updates regarding sequestration, claims processing and the use of NPPs in Home Health. Make sure to stay tuned!

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Medicare Regulatory Update (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: April 5, 2021

Welcome to Monday Minute with Melinda! This video clip will provides an update on Sequestration claims hold, Advanced & Accelerated Payments & Provider Relief Funds! Make sure to stay tuned!

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Accelerated and Advance Payment Recoupment to Begin (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 29, 2021

Welcome to Monday Minute with Melinda! This video clip will recap the process of Medicare recouping the Accelerated and Advance Payments from 2020. Make sure to stay tuned!

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COVID-19 Vaccine Administration (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: March 22, 2021

Welcome to Monday Minute with Melinda! This week’s video clip will discuss the billing and reimbursement for COVID-19 Vaccine Administration. Make sure to stay tuned!

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Wrap Your Arms Around the RAP – Request for Anticipated Payment 2021

By Melinda A. Gaboury, CEO / Posted on: December 29, 2020

Beginning 1/1/2021 the Request for Anticipated Payment (RAP) will no longer have a 20% payment associated with its processing. The RAP will continue to be a requirement for payment and ironically will be associated with a penalty if it is not accepted at the Medicare Administrative Contractor (MAC) by Day 5, the begin date of the payment period being Day 0. The penalty will be a daily amount as a proportion of the 30-day value related to the HIPPS code that the 30-day payment period is worth.

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Home Health Proposed Payment Rule CY2021

By Melinda A. Gaboury, CEO / Posted on: August 3, 2020

CMS released the CY 2021 Home Health Proposed Payment Rule in June 2020. The proposed rule contains several updates and changes. These changes include PDGM Rates, Wage Index, Telehealth, Quality Reporting Program, and Billing RAPS. The RAP issue alone is enough to warrant EVERY agency in the nation sending in comments and requesting that this be changed! We must stand together.

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New Advanced Beneficiary Notice of Noncoverage (ABN) – Home Health and Hospice

By Leslie Heagy, RN, COS-C / Posted on: July 1, 2020

CMS announced the renewal of the Advanced Beneficiary Notice (ABN). The new ABN form is effective for use on or after August 31, 2020. Home Health and Hospice Providers need to ensure they are using the most current form. All Medicare Beneficiaries and Healthcare Providers have rights and are protected against financial liability through an Advanced Beneficiary Notice (ABN). Home Health providing care under Part A or Part B and Hospice providers under Part A are responsible for giving this notice to the beneficiary in situations where Medicare payment is expected to be denied.

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COVID-19: Interim Final Rule & What It Means for Home Health

By Melinda A. Gaboury, CEO / Posted on: May 14, 2020

There have been two Interim Final Rules, the most recent on May 1, that have been issued by CMS during this historic pandemic of the century. This Public Health Emergency (PHE) has taken the full focus of national officials and in the process, there have been sweeping concessions for healthcare, some permanent and others temporary.

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COVID-19: Emergency Financial Relief for Home Health & Hospice Providers

By Melinda A. Gaboury, CEO / Posted on: April 20, 2020

(UPDATED – 05/14/2020) The CMS Accelerated and Advance Payments Program program was suspended on April 26, 2020 and no further Accelerated Payments are happening at this time. During this Public Health Emergency (PHE) there are several avenues of obtaining cash to keep your agency going. This article addresses two of those. The Accelerated and Advance Payments Program allows agencies to get an advance on Medicare payments and it must be repaid. The other is the CARES Act Provider Relief Fund that is being automatically disbursed. Agencies will not need to repay these funds, however, there are accountability requirements for accepting and using these funds.

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COVID-19: Imperative Home Health and Hospice Updates

By Melinda A. Gaboury, CEO / Posted on: April 1, 2020

This article was last updated on May 7, 2020.

As we are facing the pandemic of the century, home health and hospices are on the frontline of this Public Health Emergency (PHE) along with hospitals, physicians and all other healthcare workers. We at Healthcare Provider Solutions, Inc. would like to take this moment to thank each and every one of you for your true dedication to treating patients and helping the world to be a healthier place. HPS is dedicated to providing the Home Health and Hospice industries with the education and resources necessary to keep you performing at the highest level of success.

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PDGM Series: The 2020 Proposed Rule Update

By Melinda A. Gaboury, CEO / Posted on: August 27, 2019

January 1, 2020 will bring many new beginnings, including the Patient Driven Groupings Model (PDGM). No doubt the largest reimbursement system overhaul in home health since October 2000.
CMS continues to tweak the model and updates to the Claims Processing Manuals have begun.

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OASIS-D1 Update & PDGM Impact

By Melinda A. Gaboury, CEO / Posted on: July 1, 2019

CMS has announced that the revised OASIS-D1 instruments will be effective January 1, 2020. Changes to the OASIS-D data set and data collection guidance were finalized in the Calendar Year (CY) 2019 HH Final Rule, CMS 1689-FC.

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Are You Prepared? The Patient Driven Groupings Model (PDGM) Is Coming Soon

By Melinda A. Gaboury, CEO / Posted on: April 30, 2019

Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.

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Review Choice Demonstration Implementation Plan

By Melinda A. Gaboury, CEO / Posted on: April 3, 2019

The choice selection period for HHAs located in Illinois will begin on April 17, 2019 and end on May 16, 2019. Agencies in the other four targeted states; Ohio, North Carolina, Texas and Florida, should begin immediate preparation for RCD as it is imminent in your state!

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7 Best Practices and Tips for OASIS-D Compliance and Home Health Quality Assurance

By Melinda A. Gaboury, CEO / Posted on: April 2, 2019

Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.

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The Review Choice Demonstration (RCD) Is Here!

By Melinda A. Gaboury, CEO / Posted on: March 13, 2019

The Office of Management & Budget (OMB) officially approved implementation of the Review Choice Demonstration in Home Health. Review Choice Demonstration (RCD) for Home Health Services will give providers in the demonstration states an initial choice of three options…

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Agencies at Risk for Missing FIPS Codes

By Melinda A. Gaboury, CEO / Posted on: January 30, 2019

Home Health Agencies across the country are at risk for penalties and recouped claims if the FIPS code is NOT reported on ALL CLAIMS!

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2019 Rural Add-On Changes

By Melinda A. Gaboury, CEO / Posted on: November 30, 2018

As if the changes in the payment system were not enough. Based on the 2019 Medicare Home Health Final Rule, released in early November 2018, the Rural Add-On is being completely revised.

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2019 Value Based Purchasing Proposed Changes (UPDATED)

By Melinda A. Gaboury, CEO / Posted on: August 27, 2018

The Centers for Medicare and Medicaid Service (CMS) finalized all of the proposed changes to the Value-Based Purchasing (VBP) Model for implementation January 1, 2019. One of the refinements of VBP removed five measures, while adding two new composite measures.

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2019 Home Health Proposed Payment Rule – PDGM 2020

By Melinda A. Gaboury, CEO / Posted on: August 8, 2018

The Centers for Medicare and Medicaid Service (CMS) released the CY2019 Medicare Home Health payment rule July 12, 2018. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating the proposed elements of this rule.

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Pre-Claim Review Demonstration Coming Back?

By Melinda A. Gaboury, CEO / Posted on: June 7, 2018

CMS released a Comment Request, via the Federal Register, regarding Pre-Claim Review Demonstration being set to return on or after October 2018 in Illinois, Ohio, North Carolina, Florida, and Texas. The revised demonstration would last five years and Illinois will kick off the demonstration again and will be followed by Ohio and North Carolina and later Texas and Florida.

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Targeted Probe and Educate – What We Have Learned So Far

By Melinda A. Gaboury, CEO / Posted on: March 13, 2018

Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.

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Home Health & Hospice PEPPER Reports

By Melinda A. Gaboury, CEO / Posted on: January 15, 2018

Over the past couple of years, HPS has reported and discussed that Home Health and Hospice PEPPER Reports are very important and should be reviewed by all agencies. We have also been open about the number of agencies in the country that have never opened the reports. HPS is happy to report that, for the 8 months ending December 20, 2017, 58.5% of all hospices have opened their reports. Only 5 states and 1 territory are below 50%. The sad news is that home care…

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New Medicare Beneficiary Identifiers

By Melinda A. Gaboury, CEO / Posted on: December 20, 2017

HPS has given you a couple of updates on the new Medicare Beneficiary Identifier (MBI) cards over the past few months and we continue that update today. Following are more questions answered about the new Medicare numbers and how that will affect your agency. Key dates to remember: April 1, 2018 – Patients will begin to receive new Medicare cards and agencies should begin the process of asking…

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2018 Home Health Final Rule

By Melinda A. Gaboury, CEO / Posted on: November 14, 2017

The Breaking News that has every one full of excitement and hope is that the 2018 Home Health Final Rule does NOT include finalizing HHGM, at this time, which was set for implementation in 2019! The battle has been won, BUT the war has just begun! Some form of payment reform will occur in home health. It is not…

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Claim Denials Due to NO OASIS Will Now Return to Provider

By Melinda A. Gaboury, CEO / Posted on: October 23, 2017

The claim edit that has been in place since April 3, 2017 has been denying home health claims, at the point of billing, if the matching OASIS was not in the ASAP database. Some of these denials have been the result of data not matching between the claim and the OASIS, primarily the patient’s HIC number being different or the OASIS…

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New Medicare Cards – Questions Answered

By Melinda A. Gaboury, CEO / Posted on: October 10, 2017

HPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal…

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Targeted Probe and Educate

By Melinda A. Gaboury, CEO / Posted on: September 25, 2017

HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.

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2018 Home Health Proposed Payment Rule – Including Intro to HHGM

By Melinda A. Gaboury, CEO / Posted on: July 31, 2017

The Centers for Medicare and Medicaid Service (CMS) released the CY2018 Medicare Home Health payment rule last week. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating on the proposed elements of this rule.

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Delayed Implementation of Home Health CoPs

By Melinda A. Gaboury, CEO / Posted on: July 14, 2017

Last week CMS issued a Final Rule that changed the new Home Health CoPs rule implementation date to January 13, 2018. HPS announced the proposed rule a few months ago. NAHC and the Forum of State Associations spearheaded this effort to postpone the rule because of the extensive changes that are…

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Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier

By Aaron Carey / Posted on: June 22, 2017

Former President Harry S. Truman was the very first Medicare beneficiary to be issued a Health Insurance Claim Number (HICN) when then President Lyndon B Johnson signed the Medicare program into law on July 30, 1965. Ever since then, Medicare beneficiaries upon entitlement, have been issued a Health Insurance Claim Number (HICN). The primary issuer of the HICN is the social security administration with the railroad retirement Board issuing HIC numbers for railroad workers. Beginning in 2018 the Medicare HIC number will be replaced with a new identifier called a Medicare Beneficiary Identifier (MBI). The MBI numbers will be…

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Home Health PEPPER is HOT!

By Melinda A. Gaboury, CEO / Posted on: May 26, 2017

One of the Hot Topics surrounding the medical review contractors and Medicare MACs is Home Health PEPPER (Program for Evaluating Payment Patterns Electronic Report)! Pepper is an accumulation and calculation of certain statistics that result from claims data. These Medicare claims data statistics are calculated for areas that may be at risk for improper Medicare payments such as…

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How To Access The Provider Statistical & Reimbursement Report

By Aaron Carey / Posted on: March 17, 2017

It is that time of year again. Cost report season for home health and hospice providers. Cost reports are due five months after your agency fiscal year end. For agencies with a 12/31/16 fiscal year end cost reports are due by 05/31/17.

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HIPAA for Home Care | Establishing A Compliant Agency

By Drew Rowley / Posted on: March 3, 2017

HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?

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Are You Thriving?

By Melinda A. Gaboury, CEO / Posted on: January 20, 2017

The constant additions of new programs and new methods, updates and consideration of changes is almost unbearable for some agencies. Home Health has been hit really hard since 2008 and no relief seems to be coming. Value-Based Purchasing, Pre-Claim Review, New CoPs, OASIS-C2, ICD-10 CM and now possibly major changes to the Prospective Payment System in regard to reimbursement.

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Are you G Code Savvy?

By Melinda A. Gaboury, CEO / Posted on: January 13, 2017

Many have not yet realized that there were additional G codes introduced that went into effect January 1, 2017. These codes were not a part of the 2017 Home Health Final Rule, but were introduced in the CR9736 issued November 10, 2016.

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Late NOE Exceptions Clarified

By Melinda A. Gaboury, CEO / Posted on: January 4, 2017

Notices of Election (NOE) that are filed and/or accepted at the Medicare Administrative Contractor (MAC) outside of the required 5 calendar day requirement, penalizes the hospice and the hospice does not receive reimbursement for any services until the NOE is accepted at the MAC. There have been some significant reimbursement issues with hospices due to this requirement, even when the issue was out of the control of the hospice and due to a Medicare system processing issue.

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